Investigating breast changes

Monday 2 November, 2009

Reviewed by: Dr Meron Pitcher (Chair VCOG Breast Cancer Committee), Surgeon, Western Hospital

On this page: Clinical breast examination Imaging tests Non-surgical biopsy Surgical biopsy Further information


If you or your doctor find an unusual change in your breast there are 3 types of tests commonly used to help find the cause of the change.

This is known as the ‘triple' test and involves:

  1. clinical breast examination and taking a personal history
  2. imaging tests (such as mammogram and ultrasound)
  3. non-surgical biopsies (such as fine-needle aspiration and core biopsy).
An additional test, surgical biopsy, may also be required for some patients.

Clinical breast examination

Your doctor will examine your breasts by feeling and looking at them. If you have noticed a specific change such as a lump, try to locate the area clearly. This will help your doctor with the examination. Your doctor may also ask if there is a history of breast cancer in your family.

Your doctor may then advise you to have some tests so that a definite diagnosis can be made and to make sure your problem is not cancer. These tests may include one or more of the following.

Imaging tests

Mammogram

If you have a breast change such as a lump, a mammogram is often used to help work out the cause of the breast change. A mammogram is a low-dose x-ray of the breast tissue and only takes a few minutes. To investigate a breast change, x-rays may need to be taken from several different angles. When a breast x-ray (mammogram) is taken, the breast is flattened between 2 plates of the x-ray machine for a few seconds. It can find very small breast cancers that cannot be felt.

If a change or lump is picked up by a mammogram, further tests will be needed to work out whether it is breast cancer or a benign (not cancerous) breast condition.

Ultrasound

An ultrasound test uses high-frequency soundwaves to scan your breasts. It is similar to the ultrasound used for women who are pregnant. Ultrasound does not use radiation.

A radiographer moves a probe (which looks similar to a microphone) across your breast for this test. An image shows up on a screen (like a television screen). A solid lump will look solid on the screen while a fluid-filled cyst will look hollow.

Ultrasound is often used to help investigate breast changes in younger women because their breasts are denser and may be difficult to read on mammogram.

Non-surgical biopsy

Fine needle aspiration

Your doctor will use a syringe with a very fine needle to take fluid or cells from the area in your breast that is being investigated. This can be uncomfortable but is not usually painful. If a lump is a cyst, taking fluid in this way will usually make the cyst disappear. However, if a lump is solid, your doctor may use this test to take some cells from it. The cells will then be sent to a laboratory for further tests.

Core biopsy

This is a way of taking a tiny piece of breast tissue using a wider needle. It is used when fine-needle aspiration hasn't provided enough information.

Local anaesthetic is used to numb the breast area before the tissue is taken, however there can be some discomfort and bruising after the procedure. The tissue is then sent to the laboratory for testing. A mammogram or ultrasound may be used during a core biopsy to show the doctor the exact location of the abnormal breast tissue from which the biopsy is to be taken.

Surgical (open) biopsy

If the area of the breast that needs investigation is deep within the breast or difficult to reach with a needle, a surgical biopsy may be needed. Surgical biopsies are normally done in hospital under general anaesthetic (which means you will be unconscious).

The lump or sample of tissue is removed so it can be tested in a laboratory. You will need to stay in hospital for a day, but normally not overnight. The amount of tissue taken depends on where the lump is and how big it is. If the abnormal area can't be felt easily, a small wire may be inserted into the breast, under local anaesthetic, before the surgical biopsy to show the surgeon the location of the abnormal area.

If you are unsure about how the biopsy will be done, ask the surgeon to tell you exactly what is involved. You may want to ask about the position and size of the scar, whether you will feel any pain or discomfort, how long you will need to recover and when you will get the results. 

Further information

Having a breast problem can be very stressful, particularly if you need lots of tests. While you may be happy to get clear results, it may still take a little while to stop worrying. Ask your doctor about further check-ups. Talking with your partner, family or friends can be helpful, or you can call the Cancer Council on 13 11 20.


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